The opioid crisis in American affects more than individuals suffering from the disease of addiction or substance use disorder. The crisis is hard on their families as demonstrated by the rise in the number of children suffering from neglect and abuse leading to their placement in foster care as a result of opioid and other substance use by their parents. And it is particularly hard on babies who are exposed to substance use in utero. These children exhibit a collection of symptoms known as Neonatal Abstinence Syndrome (NAS) if exposed not only to opioids but also non-opioid drugs like antidepressants.
As stated in a recent informational bulletin from CMS, NAS is a significant and rapidly growing public health concern that results in a range of withdrawal symptoms although long-term ramifications are not fully known. An estimated four out of five infants exhibiting NAS receive health coverage through Medicaid.
The CMS guidance goes into detail about diagnosis and treatment, emphasizing that NAS is not an addition of substance use disorder but a ‘physiologic response” when an infant ceases to be exposed to the drug. NAS is treatable and generally does not require treatment with medication that may widely be used to treat substance use disorder in adults. The bulletin details helpful treatment such as ensuring that mothers reside/room-in with the infant, have skin-to-skin contact and breastfeed.
The guidance is specific about coverage of services under Medicaid and how services must meet three requirements: freedom of choice of providers; comparability of services; and statewide access. It’s worth highlighting that in defining comparability, CMS points out that states must offer the same amount, duration and scope of services to all members of an eligibility group. This means that any child under age 21 who has not been diagnosed with NAS but has comparable needs to a child diagnosed with NAS must be offered the same amount, duration and scope of services. It emphasizes, as we do, that children in Medicaid are guaranteed EPSDT benefits so that all medically-necessary services that can be covered under Medicaid must be provided to children with a medical need.
The bulletin discusses the use of non-hospital residential treatment settings or providing home-based services. It further describes services that are available to Medicaid-eligible mothers of infants with NAS but also clarifies that non-Medicaid eligible mothers may receive some benefit from services that are directed at treating and promoting the health of the child. For example, non-Medicaid eligible mothers could receive counseling in how to care for and interact with her child. This is another important benefit that EPSDT provides to children in Medicaid. However, as my colleague Adam points out, the Trump administration is missing an opportunity to more comprehensively address substance use disorder by encouraging states to expand Medicaid to all low-income adults.
Like all CMS guidance, it is intended to help states better understand their responsibilities and options in regard to the administration of Medicaid. But it’s also helpful for stakeholders who may want to advocate for their state to take more innovative approaches to treating these families and accelerating their path to recovery.